MEDICARE: DR. LYSANDER BORRERO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	9397	PR

General Provider Information

NPI Number	:	1184628836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYSANDER BORRERO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 817
Second Line	:
City	:	GUAYAMA
State	:	PR
Zip	:	00785
Country	:	US
Telephone Number	:	787-929-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	AVE. ASHFORT-URB. GIBRALTAR #1 OFICINA-3(BAJOS)
Second Line	:	AVE. ASHFORT-URB. GIBRALTAR #1 OFICINA-3(BAJOS)
City	:	GUAYAMA
State	:	PR
Zip	:	00784
Country	:	US
Telephone Number	:	787-864-6898
Fax Number	:	787-864-6895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/12/2024

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